supporting new nurse transition into practice during the ......new nurse virtual support groups...

47
Supporting New Nurse Transition into Practice during the Covid-19 Pandemic Opportunities for Academic & Practice Nurse Educator Collaboration

Upload: others

Post on 01-Oct-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Supporting New Nurse Transition into Practice during the Covid-19 Pandemic Opportunities for Academic amp Practice Nurse Educator Collaboration

Academic and practice educators have long shared a common goal to ensure new nurses transition into practice smoothly however the COVID-19 pandemic has added complexity and disruption for new nurses schools of nursing and healthcare organizations Educators from both academic and practice settings joined a task force that was co-led by the Organization of Nurse Leaders and the Massachusetts Rhode Island League for Nursing with the goal of producing recommendations to support new nurse transition into practice during this dynamic and uncertain time Academic nurse educators identified unique challenges encountered by nursing students graduating in 2020 and nurse educators from practice settings described atypical conditions in the clinical environment in which resources were distributed in creative ways to prepare for and respond to patient needs during the pandemic Collectively task force members identified strategies that could be broadly adopted to support new nurse transition into practice Information in this document can be used to guide discussions between academic and practice partners Opportunities for collaboration between academic and practice educators to support new nurses transitioning into practice during the COVID-19 pandemic are presented These opportunities are framed by two main areas to support new nurse transition into practice bull Preceptor developmentbull Support groups and resources for new nurses

Foreward

Authors amp Task Force Members

Preceptor Assessment amp Development Workgroup

Cheryl Williams PhD RN CNE NP-CMelissa OMalley Tuomi PhD RN CPHQKaren Fotino DNP APRN RN AGCNS-BC RN-BC CMSRNTamera Corsaro MSN RN CRRNDonna Chase MHAMS RNJanet Monagle PhD RN CNEDiane Welch DNP RN CNE

New Nurse Support Group and Resource Development Workgroup

Editors

Lisa Jean Thomas PhD RN CNEJoAnn Mulready-Shick EdD RN CNE ANEFSharon Perkins DNP RN CRRN ACNS-BCTom Gunning MSN RNBeth Campbell MSN RN

Ashley Waddell PhD RNAmanda Stefancyk Oberlies PhD MBA RN CENPMelissa OMalley Tuomi PhD RN CPHQJoAnn Mulready-Shick EdD RN CNE ANEF

0104

13

IntroductionPart I Preceptor Assessment and Development Recommendations Preceptor Gap Analysis Preceptor Competencies Preceptor Development Modules Best Practices for Recruiting and Retaining Preceptors Demonstrate Preceptor Return on InvestmentPart II Support for Newly Graduated Nurses New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX- RN Preparation ConclusionReferencesAppendices A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model B Preceptor Gap Analysis C Evidence-based Preceptor Selection and Development Checklist D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection E Preceptor Development Module 2 Clinical Judgment Continued F Preceptor Development Module 3 How to Give Constructive Feedback G Reflective Journaling Guide H Resources to Support Professional Role Development Among New Nurses I Resources to Clinical Skills Development Among New Nurses J COVID-19 Resources K Cues for Addressing Disruptive Behavior L Certificate Modules

Contents

272322

Introduction

During ordinary circumstances the first year of employment for new graduate nurses can be challenging In 2020 this transition may be even more arduous as newly graduated nurses are entering practice during the COVID-19 pandemic

01

Nursing Student Considerations

The COVID-19 pandemic conditions prevented nursing students in the Northeast region of the country and elsewhere from participating in traditional clinical experiences during the spring semester of 2020 Schools of Nursing worked to identify innovative solutions to provide clinical and simulation experiences However as new graduate nurses enter into the workforce it will be important for healthcare organizations professional development specialists educators and preceptors to be mindful of the disruption to their clinical education New nurses are entering practice with varied clinical experiencemdashmost will have had less clinical education than graduates before them Many however have work experience as a clinical nursing assistants or in other supportive roles during the pandemic response These variabilities underscore the need for professional development specialists to vigilantly assess and re-evaluate new nurses as they transition into practice during the pandemic

As states across the country declared a State of Emergency many governors issued executive orders allowing new nurses to practice prior to sitting for the NCLEX-RN licensure exam As a result many healthcare organizations (HCO) hired newly graduated nursing students into practice Transitioning graduate nurses into practice prior to taking the licensure exam may serve two purposes to help reinforce skills in preparation for the NCLEX-RN exam and to keep new graduates in the learning mindset However this strategy may also create the potential for new unlicensed nurses who may not have completed their clinical experiences to enter practice with different learning social and emotional needs

02

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 2: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Academic and practice educators have long shared a common goal to ensure new nurses transition into practice smoothly however the COVID-19 pandemic has added complexity and disruption for new nurses schools of nursing and healthcare organizations Educators from both academic and practice settings joined a task force that was co-led by the Organization of Nurse Leaders and the Massachusetts Rhode Island League for Nursing with the goal of producing recommendations to support new nurse transition into practice during this dynamic and uncertain time Academic nurse educators identified unique challenges encountered by nursing students graduating in 2020 and nurse educators from practice settings described atypical conditions in the clinical environment in which resources were distributed in creative ways to prepare for and respond to patient needs during the pandemic Collectively task force members identified strategies that could be broadly adopted to support new nurse transition into practice Information in this document can be used to guide discussions between academic and practice partners Opportunities for collaboration between academic and practice educators to support new nurses transitioning into practice during the COVID-19 pandemic are presented These opportunities are framed by two main areas to support new nurse transition into practice bull Preceptor developmentbull Support groups and resources for new nurses

Foreward

Authors amp Task Force Members

Preceptor Assessment amp Development Workgroup

Cheryl Williams PhD RN CNE NP-CMelissa OMalley Tuomi PhD RN CPHQKaren Fotino DNP APRN RN AGCNS-BC RN-BC CMSRNTamera Corsaro MSN RN CRRNDonna Chase MHAMS RNJanet Monagle PhD RN CNEDiane Welch DNP RN CNE

New Nurse Support Group and Resource Development Workgroup

Editors

Lisa Jean Thomas PhD RN CNEJoAnn Mulready-Shick EdD RN CNE ANEFSharon Perkins DNP RN CRRN ACNS-BCTom Gunning MSN RNBeth Campbell MSN RN

Ashley Waddell PhD RNAmanda Stefancyk Oberlies PhD MBA RN CENPMelissa OMalley Tuomi PhD RN CPHQJoAnn Mulready-Shick EdD RN CNE ANEF

0104

13

IntroductionPart I Preceptor Assessment and Development Recommendations Preceptor Gap Analysis Preceptor Competencies Preceptor Development Modules Best Practices for Recruiting and Retaining Preceptors Demonstrate Preceptor Return on InvestmentPart II Support for Newly Graduated Nurses New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX- RN Preparation ConclusionReferencesAppendices A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model B Preceptor Gap Analysis C Evidence-based Preceptor Selection and Development Checklist D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection E Preceptor Development Module 2 Clinical Judgment Continued F Preceptor Development Module 3 How to Give Constructive Feedback G Reflective Journaling Guide H Resources to Support Professional Role Development Among New Nurses I Resources to Clinical Skills Development Among New Nurses J COVID-19 Resources K Cues for Addressing Disruptive Behavior L Certificate Modules

Contents

272322

Introduction

During ordinary circumstances the first year of employment for new graduate nurses can be challenging In 2020 this transition may be even more arduous as newly graduated nurses are entering practice during the COVID-19 pandemic

01

Nursing Student Considerations

The COVID-19 pandemic conditions prevented nursing students in the Northeast region of the country and elsewhere from participating in traditional clinical experiences during the spring semester of 2020 Schools of Nursing worked to identify innovative solutions to provide clinical and simulation experiences However as new graduate nurses enter into the workforce it will be important for healthcare organizations professional development specialists educators and preceptors to be mindful of the disruption to their clinical education New nurses are entering practice with varied clinical experiencemdashmost will have had less clinical education than graduates before them Many however have work experience as a clinical nursing assistants or in other supportive roles during the pandemic response These variabilities underscore the need for professional development specialists to vigilantly assess and re-evaluate new nurses as they transition into practice during the pandemic

As states across the country declared a State of Emergency many governors issued executive orders allowing new nurses to practice prior to sitting for the NCLEX-RN licensure exam As a result many healthcare organizations (HCO) hired newly graduated nursing students into practice Transitioning graduate nurses into practice prior to taking the licensure exam may serve two purposes to help reinforce skills in preparation for the NCLEX-RN exam and to keep new graduates in the learning mindset However this strategy may also create the potential for new unlicensed nurses who may not have completed their clinical experiences to enter practice with different learning social and emotional needs

02

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 3: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Authors amp Task Force Members

Preceptor Assessment amp Development Workgroup

Cheryl Williams PhD RN CNE NP-CMelissa OMalley Tuomi PhD RN CPHQKaren Fotino DNP APRN RN AGCNS-BC RN-BC CMSRNTamera Corsaro MSN RN CRRNDonna Chase MHAMS RNJanet Monagle PhD RN CNEDiane Welch DNP RN CNE

New Nurse Support Group and Resource Development Workgroup

Editors

Lisa Jean Thomas PhD RN CNEJoAnn Mulready-Shick EdD RN CNE ANEFSharon Perkins DNP RN CRRN ACNS-BCTom Gunning MSN RNBeth Campbell MSN RN

Ashley Waddell PhD RNAmanda Stefancyk Oberlies PhD MBA RN CENPMelissa OMalley Tuomi PhD RN CPHQJoAnn Mulready-Shick EdD RN CNE ANEF

0104

13

IntroductionPart I Preceptor Assessment and Development Recommendations Preceptor Gap Analysis Preceptor Competencies Preceptor Development Modules Best Practices for Recruiting and Retaining Preceptors Demonstrate Preceptor Return on InvestmentPart II Support for Newly Graduated Nurses New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX- RN Preparation ConclusionReferencesAppendices A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model B Preceptor Gap Analysis C Evidence-based Preceptor Selection and Development Checklist D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection E Preceptor Development Module 2 Clinical Judgment Continued F Preceptor Development Module 3 How to Give Constructive Feedback G Reflective Journaling Guide H Resources to Support Professional Role Development Among New Nurses I Resources to Clinical Skills Development Among New Nurses J COVID-19 Resources K Cues for Addressing Disruptive Behavior L Certificate Modules

Contents

272322

Introduction

During ordinary circumstances the first year of employment for new graduate nurses can be challenging In 2020 this transition may be even more arduous as newly graduated nurses are entering practice during the COVID-19 pandemic

01

Nursing Student Considerations

The COVID-19 pandemic conditions prevented nursing students in the Northeast region of the country and elsewhere from participating in traditional clinical experiences during the spring semester of 2020 Schools of Nursing worked to identify innovative solutions to provide clinical and simulation experiences However as new graduate nurses enter into the workforce it will be important for healthcare organizations professional development specialists educators and preceptors to be mindful of the disruption to their clinical education New nurses are entering practice with varied clinical experiencemdashmost will have had less clinical education than graduates before them Many however have work experience as a clinical nursing assistants or in other supportive roles during the pandemic response These variabilities underscore the need for professional development specialists to vigilantly assess and re-evaluate new nurses as they transition into practice during the pandemic

As states across the country declared a State of Emergency many governors issued executive orders allowing new nurses to practice prior to sitting for the NCLEX-RN licensure exam As a result many healthcare organizations (HCO) hired newly graduated nursing students into practice Transitioning graduate nurses into practice prior to taking the licensure exam may serve two purposes to help reinforce skills in preparation for the NCLEX-RN exam and to keep new graduates in the learning mindset However this strategy may also create the potential for new unlicensed nurses who may not have completed their clinical experiences to enter practice with different learning social and emotional needs

02

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 4: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

0104

13

IntroductionPart I Preceptor Assessment and Development Recommendations Preceptor Gap Analysis Preceptor Competencies Preceptor Development Modules Best Practices for Recruiting and Retaining Preceptors Demonstrate Preceptor Return on InvestmentPart II Support for Newly Graduated Nurses New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX- RN Preparation ConclusionReferencesAppendices A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model B Preceptor Gap Analysis C Evidence-based Preceptor Selection and Development Checklist D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection E Preceptor Development Module 2 Clinical Judgment Continued F Preceptor Development Module 3 How to Give Constructive Feedback G Reflective Journaling Guide H Resources to Support Professional Role Development Among New Nurses I Resources to Clinical Skills Development Among New Nurses J COVID-19 Resources K Cues for Addressing Disruptive Behavior L Certificate Modules

Contents

272322

Introduction

During ordinary circumstances the first year of employment for new graduate nurses can be challenging In 2020 this transition may be even more arduous as newly graduated nurses are entering practice during the COVID-19 pandemic

01

Nursing Student Considerations

The COVID-19 pandemic conditions prevented nursing students in the Northeast region of the country and elsewhere from participating in traditional clinical experiences during the spring semester of 2020 Schools of Nursing worked to identify innovative solutions to provide clinical and simulation experiences However as new graduate nurses enter into the workforce it will be important for healthcare organizations professional development specialists educators and preceptors to be mindful of the disruption to their clinical education New nurses are entering practice with varied clinical experiencemdashmost will have had less clinical education than graduates before them Many however have work experience as a clinical nursing assistants or in other supportive roles during the pandemic response These variabilities underscore the need for professional development specialists to vigilantly assess and re-evaluate new nurses as they transition into practice during the pandemic

As states across the country declared a State of Emergency many governors issued executive orders allowing new nurses to practice prior to sitting for the NCLEX-RN licensure exam As a result many healthcare organizations (HCO) hired newly graduated nursing students into practice Transitioning graduate nurses into practice prior to taking the licensure exam may serve two purposes to help reinforce skills in preparation for the NCLEX-RN exam and to keep new graduates in the learning mindset However this strategy may also create the potential for new unlicensed nurses who may not have completed their clinical experiences to enter practice with different learning social and emotional needs

02

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 5: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Introduction

During ordinary circumstances the first year of employment for new graduate nurses can be challenging In 2020 this transition may be even more arduous as newly graduated nurses are entering practice during the COVID-19 pandemic

01

Nursing Student Considerations

The COVID-19 pandemic conditions prevented nursing students in the Northeast region of the country and elsewhere from participating in traditional clinical experiences during the spring semester of 2020 Schools of Nursing worked to identify innovative solutions to provide clinical and simulation experiences However as new graduate nurses enter into the workforce it will be important for healthcare organizations professional development specialists educators and preceptors to be mindful of the disruption to their clinical education New nurses are entering practice with varied clinical experiencemdashmost will have had less clinical education than graduates before them Many however have work experience as a clinical nursing assistants or in other supportive roles during the pandemic response These variabilities underscore the need for professional development specialists to vigilantly assess and re-evaluate new nurses as they transition into practice during the pandemic

As states across the country declared a State of Emergency many governors issued executive orders allowing new nurses to practice prior to sitting for the NCLEX-RN licensure exam As a result many healthcare organizations (HCO) hired newly graduated nursing students into practice Transitioning graduate nurses into practice prior to taking the licensure exam may serve two purposes to help reinforce skills in preparation for the NCLEX-RN exam and to keep new graduates in the learning mindset However this strategy may also create the potential for new unlicensed nurses who may not have completed their clinical experiences to enter practice with different learning social and emotional needs

02

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 6: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Nursing Student Considerations

The COVID-19 pandemic conditions prevented nursing students in the Northeast region of the country and elsewhere from participating in traditional clinical experiences during the spring semester of 2020 Schools of Nursing worked to identify innovative solutions to provide clinical and simulation experiences However as new graduate nurses enter into the workforce it will be important for healthcare organizations professional development specialists educators and preceptors to be mindful of the disruption to their clinical education New nurses are entering practice with varied clinical experiencemdashmost will have had less clinical education than graduates before them Many however have work experience as a clinical nursing assistants or in other supportive roles during the pandemic response These variabilities underscore the need for professional development specialists to vigilantly assess and re-evaluate new nurses as they transition into practice during the pandemic

As states across the country declared a State of Emergency many governors issued executive orders allowing new nurses to practice prior to sitting for the NCLEX-RN licensure exam As a result many healthcare organizations (HCO) hired newly graduated nursing students into practice Transitioning graduate nurses into practice prior to taking the licensure exam may serve two purposes to help reinforce skills in preparation for the NCLEX-RN exam and to keep new graduates in the learning mindset However this strategy may also create the potential for new unlicensed nurses who may not have completed their clinical experiences to enter practice with different learning social and emotional needs

02

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 7: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Healthcare Organization Considerations

Organizations went through a rapid period of substantial change to prepare for and respond to the COVID-19 pandemic Some patient care units were closed new units were opened non-emergent surgical services were stopped and ambulatory visits were conducted virtually The structural changes had significant implications for staff including nurses Experienced clinical staff in HCOs were deployed to provide leadership and care in new units or to participate in trainingup-skilling in other areas resulting in some HCOs indicating a need for additional preceptors to onboard new staff Compounding this clinical educators were deeply involved in supporting the movement of nurses within organizations as many nurses and staff began working on unfamiliar units which required new clinical knowledge and skills Structuring orientations trainings additional preceptor classes became increasingly challenging for professional development specialists and clinical educators

Transitioning of new nurses into practice during the COVID-19 pandemic required new thinking and new strategies thus a collaborative academicpractice taskforce co-led by the Massachusetts Rhode Island League for Nursing (MARILN) and The Organization of Nurse Leaders MA RI CT NH VT (ONL) was established Taskforce members consisted of faculty at schools of nursing educators in practice settings and one dean from a school of nursing The goal of the taskforce was to identify strategies that would help new nurses successfully transition into practice during this unprecedented time Members of the taskforce determined that an academic-practice partnership strategy through partnership new strategies could best support the onboarding of new nurses during the COVID-19 pandemic Integrated academic-service partnerships can improve patient outcomes through improved evidence-based patient care (Granger et al 2012) and strengthening these partnerships could leverage scarce resources for all The initial taskforce meetings resulted in the development of two workgroupsmdashone to address the need for more preceptors in HCOs and the other to addressed supports for new nurses as they transition into practice The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) was used as a guiding framework

Background

03

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 8: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Part I Preceptor Assessment and Development

The importance of the preceptor in new nurse retention and patient safety cannot be minimized Novice nurses need more than 12 months of orientation and may not reach beyond advanced beginner functioning for 2-3 years (Monagle Lasater Stoyles amp Dieckmann 2018) As many as 26 of newly licensed nurses leave within the first two years of practice making those beginning years critical (Kovner et al 2014) Strong preceptor programs have been shown to decrease turnover rates among new staff and improve new graduate nurse retention but recruiting and retaining effective preceptors can still be a challenge for organizations (Friedman Delaney Schmidt Quinn amp Macyk 2013 Kovner et al 2007 Ulrich et al 2010) Further of all the variables examined in a systematic review the number one factor for success cited by new nurses was having ldquoa designated resource personrdquo or preceptor (Innes and Calleja 2018) The pandemic has strained healthcare organizations in numerous ways depending on the extent of the COVID-19 surge in the region For areas hard hit experienced clinical staff in HCOs were deployed to provide leadership and care in new clinical units or to participate in trainingupskilling in other units resulting in some HCOs indicating a need for additional preceptors assist with onboarding of new nurses

As role models preceptors facilitate learning evaluate practice and socialize the new nurse as they transition into practice Supporting and developing preceptors is a worthy endeavor in normal circumstances but is even more critical in the context of the COVID-19 pandemic Taskforce members explored solutions that could be implemented quickly while also providing a long-term return on investment For example skilled and experienced nurses are often asked to precept yet these are also the very nurses who are likely deeply engaged in the pandemic response Therefore taskforce members accounted for innovative ways to utilize newer staff as preceptors The grouprsquos priority was to balance best practices for clinical teaching and academic expertise with onboarding and orientation best practices and clinical educator expertise

04

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 9: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Recommendations

The following recommendations are designed to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic The recommendations focus on short-term and easily implementable strategies to strengthen the cadre of available preceptors while also providing a long-term return on investment However task force members recommend a longer-term and more sustainable action plan be developed and retain strong preceptors should be developed The following steps will guide organizations through a process of preceptor assessment and development asynchronous and alternate support ideas are provided to supplement the primary preceptor

number of new nurses they expect to hires in the next 12-18 months It is important toconsider overall resources for learning byassessing the projected number of nursing student clinical placements along with plannedhiring of novice (new to an area) nurses and new graduate nurses in their calculations of preceptor demand HCOs that place a large number of students may benefit from increasing focus on preceptor training to make the pool of skilled preceptors as large as possible Consider what is working within the organizations processes for onboarding new nurses and what additional supports and resources may be needed HCOs may benefit from connecting with other hospitals or academic partners to leverage available resources

Organizations should perform a self-assessment of their preceptor capacity and current need or a gap analysis Doing this will provide organizations with a snapshot of available resources so that they may utilize preceptor training resources efficiently and effectively As part of the gap analysis we encourage HCOs to closely work with their academic partners and communicate the

Preceptor Gap Analysis

05

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 10: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

To guide an organizations analysis a gap analysis template is available (Appendix B and on the ONL website) and includes the following considerations

The volume of new graduate nurses and anticipated volume of new hires starting in the summer or fall of 2020 (and for the next 18 months)The number of newly hirednon-new graduate nurses on orientation who will still be on orientation in the summer of 2020 (and for the next 18 months)The number of trained preceptors on each unit and the number of nurses who are not yet trained as preceptors that could be trained and engaged to support parts of orientation Dont overlook relatively new nurses such as those who completed orientation in the past 1-2 years Evaluate local resources for training and developing preceptors in addition to in-house options Some universities offer clinical faculty training Working with academic partners can help the HCO build preceptors and can also support SONs by developing staff nurses to support clinical education and developing a pool of potential clinical faculty

After performing the preceptor gap analysismdash identifying the number of available preceptors as well as the number of preceptors your organization is likely to needmdash the next step is to identify the nurses who will fill this important role

Thoughtful and purposeful selection of preceptors is important Often clinical skill and availability are the primary factors in preceptor selection particularly in times where there is a large need for preceptors The taskforce strongly recommends that preceptor selection go beyond availability and focus on skills and attributes of strong preceptors Using an evidence-based checklist to guide preceptor selection and development will strengthen the pool of preceptors available in HCOs The checklist is available in Appendix C Professional development specialists are encouraged to consider newer nurses may be effective preceptors with training and support (Cotter Eckardt amp Moylan 2018)

06

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 11: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Preceptor Competencies

Preceptor competencies align with the MA Nurse of the Future Core Competencies (Appendix A Finn amp Chesser-Smyth 2013 MA DHE 2016) and reflect competencies from the literature Preceptor Competencies Assess and Evaluate Novice Competencies A

How to deliver an evaluation

Deliver Constructive Feedback AAdvocacy- Inquiry Model (NLN) Critical Conversations (Forneris amp Fey 2018) CommunicationSBAR (Monagle Lasater Stoyles amp Dieckmann 2018)

Develop Clinical Reasoning and Critical Thinking ATannerrsquos Model (Noticing Interpreting Responding and Reflection) (Monagle Lasater Stoyles amp Dieckmann 2018)Reflective Journaling Debriefing skills (deep questioning and feedback) (Monagle Lasater Stoyles amp Dieckmann 2018)Teach prioritization

Integrate Learning Styles A Principles of Adult Education A Using Technology and Evidence-Based Decisions (National Council of State Boards of Nursing) AL Collaboration L

Conflict resolution and cognitive rehearsal LSocialization L

Preceptor and Novice Roles and Responsibilities LSocialization

Orientation L Maintaining Standards for Novices and Helping them Succeed L

Professionalism and resiliencySelf-care

A Indicates academic faculty may be able to assist practice with these competenciesL Indicates items should be reserved and completed in HCOs at the unit or departmental level

07

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 12: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Preceptor Development Modules

Preceptor development modules were developed to assist professional development specialists and practice-based nurse educators with quickly implementing a preceptor development program Specifically three preceptor development modules were developed and are available on the in the about tab in the public education section of Organization of Nurse Leaders website (wwwoonlorg) Each module consists of a short didactic video and supplemental materials that are intended to be used together by nurse educators and new preceptors Click here to access the preceptor modules An overview of Preceptor Development Modules is provided in Appendices D - F

HCOs are encouraged to use these modules and resources to implement an evidence-based preceptor development program Academic and practice partners should work together on how to best meet the needs of new preceptors Academic faculty may be able to work with practice-based educators and professional development specialists to facilitate preceptor development modules even remotely via video conference Evidence-based preceptor programs demonstrate promising results

The Vermont Nurses in Partnership (VNIP nd) offers a clinical transition framework consisting of evidence-based competency and preceptor development models Delfino et al (2015) and Boyer (2008) documented the importance and much evidence supporting the use of the VNIP modelThe National Council of State Boards of Nursing (NCSBN)Transition to Practice (TTP) model has shown promise for both preceptors and newly licensed nurses Retention and clinical competence of newly licensed nurses was seen in hospitals with structured preceptorship models (Blegen et al 2015)

08

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 13: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Best Practices for Recruiting and Retaining Preceptors

Becoming a preceptor should be something that nurses aspire to and are pleased to achieve yet it is also a role that can be demanding and time-consuming To enhance preceptor experience and retain strong clinical teachers organizations should consider the extent to which preceptors are recognized for their contribution to the success of the unit and the organization Support for preceptors has been shown to contribute to workforce retention Bontrager Hart amp Mareno (2016) found an association between preceptorship and increased job satisfaction in preceptees resulting in decreased attrition of new nurses Preceptor Support is Paramount

HCOs should consider implementing Reduced preceptor work assignments to less than a full load leaving time for teachingA preceptor toolkit with all forms and expectations to help preceptors better understand the role Some organizations reported having a ldquojob descriptionrdquo for preceptors to outline expectations Other organizations have preceptor hand-off tools as well as criteria for evaluating new nurses to make measuring their progress consistent Standardizing expectations tools and processes may be helpfulA preceptor support and mentoring forumPreceptor incentives and recognition these do not need to be monetized and could include having preceptor development qualify for CE credits professional development or certification as a preceptor (example) or recognition for preceptors such as thank you notes from unit leaders and educators andor recognition awards offered by HCOs or professional nursing organizations

Structured collaboration between local academic and practice partners to establish formal preceptor and clinical instructor programs mdash taught jointly by faculty and clinical nurse educators mdash could enhance both student and new graduate clinical experiences

Reducing the preceptorrsquos assignment scheduling the novice on the same shifts as the preceptor encouraging novice and preceptor to share assignments and keeping the number of preceptees low are some of the best preceptor practices at the organizational and departmental level (Blegen et al 2015) To support preceptors and position them to be successful in orienting new nursesHCOs should consider implementing

09

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 14: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Researchers McDonald and Ward-Smith (2012) found a high correlation between a well-designed consistent orientation process and retention Orientation during the pandemic may look different but thinking creatively about how to structure orientation around available resources will help ensure a successful orientation process and may provide additional support for preceptors Things to consider include

Where will nurses be orienting and does the learning experience improve if new nurses are started in areas outside of their ldquohomerdquo unit (such as a non-COVID area) Time on a different unit could provide a less-stressful environment and the opportunity to establish competency in basic skills and knowledge

Partner with other units that provide exposure to desired skillscompetencies and give the new graduate nurse the chance to learn patient management in multiple areas

Consider Current Resources when Planning New Nurse Orientation During the Pandemic

Consider how newer nurses (even those with one-year experience) could be utilized as part of a precepting team to orient the new graduate nurse for a period of time with a focus on clinical basics socialization and unit familiarityUtilizing newer nurses as preceptors for the first 2-3 weeks of a 12-week orientation offers a leadership opportunity to the preceptor and may enhance the socialization of the new graduate nurse by providing them with a preceptor who recently experienced the same transition to practice In addition this gives more experienced preceptors a break while still leveraging their expertise when orienting new nurses to more complex skills and critical thinkingHaving a point person and organizing preceptor handoffs are critical If using multiple preceptors design and implement a structured plan for preceptor handoffs The Nursing Executive Center identified using newer nurses as preceptors as a best practice to address the skillcomplexity gap in nursing orientation but stressed the importance of handoff between preceptors (2019)

Consider Using New Nurses as Part of a Precepting Team

10

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 15: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Consider setting weekly orientation goals for establishing clinical competence in key areas and re-visit additional needs over time

Evaluate the immediate needs of your units and consider the extent to which team composition and skill mix have shifted with the COVID-19 response Are some units more stressed than others Has the skill mix andor structure of the team providing care shifted While team nursing is not widely used it may be effective to structure patient care activities as a team when skill mix is lower or the team structure has changed This may be applied to a unit but it can also be a way to look at orientation of the new graduate nurse Orientation could be shifted to focus on practical and assessment skills development (eg all Foley catheter or IV insertions and maintenance or all telemetry strip reviewdocumentation for multiple units) (The Nursing Executive Center 2019)

Set Weekly Goals to Establish Clinical Competence

11

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 16: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Demonstrate Preceptor Return on Investment

Long term orientation and preceptor support is a valuable investment The financial burden of nurse turnover on an organization is estimated to be $36-$61 million annually for the average hospital (Nursing Solutions Inc 2019) For the new graduate nurse when accounting for time spent orienting and training the average cost is estimated to be 15 times the salary of that nurse (Nursing Executive Center 2019) Below are suggestions to advocate for increased preceptor development and orientation support despite financial challenges due to pandemic response

For professional development teams calculating the return on investment (ROI) is an effective way to make the case for increasing support for preceptor programs (Opperman Liebig Bowling amp Johnson 2016) ROI tools are available but simply comparing the cost of preceptor support and preceptor incentives to turnover may be enough to demonstrate ROI in preceptor programs

Brook et al (2019) found new nurse transition programs with teaching a preceptor and mentor in place for 27-52 weeks often yielded a ROI Hospitals with preceptors saw an average of 14 decrease in turnover rates and a 23 increase in retention As preceptor programs are linked to decreased turnover rates and the COVID-19 pandemic has put extreme financial pressures on HCOs it is important to make the case that now is not the time to shorten orientation or increase preceptor workloadNew graduate nurses are particularly at risk for turnover due to the routine stress of entering the practice up to 35 of new graduate nurses change positions each year (Phillips 2020 Windey et al 2015) The perception of peer support and other such relational resources explain the largest contribution to nurses perception of workload- greater than even staffing levels and skill mix- making this particularly important during this time when nurses are struggling with the emotional weight of the pandemic (Oppel amp Mohr 2020)

12

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 17: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Part IISupport for Newly Graduated Nurses

Some new nurses already have jobs in a practice setting while others are still looking for their first nursing job In either scenario staying connected with other new nurses and with established nurse leaders mdash such as faculty and educators mdash will provide needed supports for a smooth transition into practice Recommended strategies and identified resources are intended to support the newest nurses in their transition into practice during the 2020 COVID-19 pandemic

New Nurse Virtual Support Groups

support groups will likely benefit new nurses in their transition into practice as well as in the first several months after orientation concludes Academic and practice educators are encouraged to collaborate and co-lead forums together New nurses from HCOs and nurses who recently graduated from schools of nursing can be recruited to participate in the support groups Support group leaders are encouraged to be flexible in regard to the time and topics covered and leaders can offer discussion topics if participants do not have questions or situations that they would like to discuss Many topics can be addressed in the support forums including debriefing professional role development reflection with storytelling mentoring resources license exam preparation clinical skills development interview skills and providing information about potentially earning a certificate and developing new skill sets are seen as important components for focus within these forum gatherings By creating such forums at the local level schools and partnering clinical agencies can provide the space for identifying priority needs of the new graduate providing resources and further development and time for processing thoughts feelings and experiences Done across a region such forums can also develop the new nursesrsquo network of colleagues

New graduates will likely benefit from additional psychosocial support during this unpredictable and challenging time Despite the close relationships that can develop between new nurses and preceptors and among members of a new nurse cohort new nurses can often feel isolated and overwhelmed Providing a forum a virtual space for new graduates to process experiences and to discuss concerns or ask questions will provide both emotional and psychological support Dialogues in the virtual

13

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 18: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Objective To establish a forum for newly licensed registered nurses to process their experiences as they transition to practice in a supportive environment that provides counsel camaraderie and inclusion Consider limiting size of groups to 10 or less Duration of Support Group Meetings and Program Length Format is to be determined by facilitator(s) and the organization Members of the taskforce recommend support group sessions last for one hour Consider offering multiples dates and times for the forums to maximize new nurse attendance It is recommended that the new nurse attend one forum per week for the duration of the transition periodMeeting Platform Zoom or multi-user meeting platform of choiceModel Group SupportDebriefingFacilitator(s) Consider having two co-leads one from each organization in the academic-practice partnership Members of the taskforce recommend having an educator from the clinical practice setting and an educator from a school of nursing Facilitators should meet weekly to check in about the groups share information and plan for upcoming sessions Forum Norms At the first debriefing session ground rules are established The facilitator(s) create an environment conducive to sharing and communicates in an open empathetic and respectful manner It is extremely important for the facilitator to not be viewed as the only one with answers but rather encourages sharing and support amongst the participants (Shrinners Africa amp Hawkes 2016) It should be communicated that the discussions within the support groups are confidential and the only reason to break this rule is for patient or nurse safety issuesSupport Group Format The format for the support group should be flexible so that it can be adjusted based on the groups needs Keep in mind that attendees may vary from week to week Formats can include open discussion needs assessment or themed discussions and sharing of resources Curriculum Topics may include self-care reality shock effective communication transitioning to night shift grief management disruptive behaviors in the workplace and delegation challenges Pellico Brewer amp Kovnar (2009) identified five themes that may be useful in discussions with new nurses including colliding role expectations the need for speed- or productivity expectations you want too much- or potentially unrealistic expectation for new nurse performance how dare you- blame shame and guilt and change is on the horizon More recently study participants identified response to stress self-care reality shock-transition and reality shock from novice to expert as highly relevant topics for discussion with new nurses (Shrinners Africa amp Hawkes 2016) All of these themes and concepts can be used to structure support group discussions

Structure and Content of New Nurse Virtual Support Groups

14

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 19: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Debriefing with new graduate nurses transitioning into practice is beneficial (Shinners Africa amp Hawkes 2016) When conducted within a nursing context debriefing provides an effective vehicle for group members with shared experiences to explore feelings ask questions and express concerns in a non-threatening non-judgmental environment Debriefing sessions allow participants to reflect on and critique their experiences while providing validation enhancing self-efficacy and promoting psychological growth

Debriefing Competency-Based Professional Role Development

Reflection and storytelling can be powerful tools for processing experiences Zak (2013) communicates the impact stories have on our brain and how they can help us develop empathy The article is available for educational purposes on the ONL website by clicking here and can be used with new nurses and preceptors as a point of discussion about clinical and learning experiences Reflective journaling is another way to process experiences and can be used as part of nursing orientation to develop clinical judgment (Nielsen Stragnell amp Jester 2007) A reflective journaling guide is provided in Appendix G

Reflection and Storytelling

Two important learning outcomes during transition to practice are ongoing professional role and competency development There are many competency models including the Quality and Safety Education for Nurses (QSEN) model (QSEN 2020) that addresses competency development in safety evidence-based practice teamwork and collaboration quality improvement informatics and patient-centered care The National Council of State Boards of Nursing base their Transition to Practice Model and related courses on these competencies these are further delineated by the Massachusetts Nurse of the Future Core Competencies (NOFCC Appendix A) with the addition of communication professionalism leadership and systems-based care (Massachusetts Department of Higher Education 2016)

15

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 20: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

New Nurse Competencies

Transitioning from student to professional nurse requires understanding of teamwork and how it plays out in pressure-packed situations Having the big picture enables new graduate nurses to become part of the solution as they balance personal accountability with the collaborative efforts of the team Definition Functions effectively within nursing and interdisciplinary teams fostering open communication mutual respect and shared decision-making to achieve quality patient care The following bullets highlight potential learning objectives for new nurse development

Describe the relationship between patient safety collaboration and teamwork using SBAR and IPASS the BATON- TeamSTEPPS communication strategies (AHRQ 2020) and Clark Healthy Workplace Inventory (Clark 2015)

Communication and Teamwork

Demonstrate effective use of communication techniques with colleagues to resolve conflict disruptive behaviors and workplace violence using DESC script Cognitive Rehearsal (Longo 2017) Cues for Addressing Disruptive Behavior (Appendix K) access resources provided by the American Nurses Association- End Nurse Abuse campaign (ANA 2020) Discuss how to lead andor work cooperatively with othersDiscuss professional development opportunities for lifelong learning health policy and professional organizational work

Patient and Family-Centered Care

The Massachusetts Nurse of the Future Core Competencies (Massachusetts Department of Higher Education 2016 Appendix A) are introduced below and additional resources to support competency-based professional role development can be found in Appendix H

Nurses have a unique role in helping patients and families become partners in their care A nursersquos holistic and multidimensional role accounts for patient preferences culture values beliefs physical wellbeing home environment community and support system Definition Patient-centered care recognizes the patient as the source of control and partner in providing compassionate and coordinated care based on respect for patient preferences values and needs The following bullets highlight potential learning objectives for new nurse development

Describe patient- and family-centered careAssess and address health literacy

16

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 21: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Discuss techniques that protect patients and minimize errors including Root cause analysis of near misses and incidents Discuss how a nurse provides patient- and family-centered care and empower patients families and significant others

Evidence-Based Practice

Patients expect high quality of care when they enter a healthcare system New graduate nurses can help ensure this quality by contributing to a culture of safety This compels them to raise concerns and to actively find ways to improve care Nurse-driven initiatives can identify needed areas of improvement and make a significant difference in patient safety and satisfaction Definition Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems The following bullets highlight potential learning objectives for new nurse development

Discuss quality improvement initiatives on the clinical unit and within the organizationExplore how quality improvement is used to facilitate changeDescribe how to develop a workable quality improvement and evaluation planDiscuss how nursing quality initiatives improve patient care

Quality Improvement

As new graduate nurses learn to define priorities find supporting evidence and then suggest ways to implement findings they will build a strong foundation for long-term practice Definition Integrate best current evidence with clinical expertise and patientfamily preferences and values for delivery of optimal healthcare The following bullets highlight potential learning objectives for new nurse development

Discuss evidence-based practice as it relates to the clinical unit organization and new nurse practiceWrite a researchable clinical questionIdentify ways to find answers to the clinical questionExplore the connection between research evidence and practice guidelines

17

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 22: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

New nurses need to understand that while technology cannot replace compassionate and skillful nursing care it can facilitate communication and decision making in the clinical workflow Everyone on the healthcare team including patients and their families can use this information to generate new knowledge and create caring interventions and evidence-based personalized plans of care Definition Use information and technology to communicate manage knowledge mitigate error and support decision-making The following bullets highlight potential learning objectives for new nurse development

Discuss how informatics supports a learning health systemDistinguish between data information and knowledgeArticulate how health information technology is used to manage patient informationExplain how connected care tools are used to enhance health outcomes

Informatics

Nurses have an important role in contributing to and overseeing safe patient care Definition Minimizes risks of harm to patients and providers through both system effectiveness and individual performance The following bullets highlight potential learning objectives for new nurse development

Discuss how to adopt proven communication strategies that reduce errors The taskforce recommends TeamSTEPPS (Agency for Healthcare Research and Quality 2020) strategies for assertiveness (Two Challenge Rule CUS)Discuss strategies for prevention of medication errors and the complexity of human factorsDiscuss just culture fairness accountability and error reporting in complex systems (National Health Services 2018)Discuss novice nurse as error-prone Help new nurses practice time management skills prioritization skills delegation skills clinical judgment clinical reasoning and decision-making skills (Spector Ulrich amp Barnsteiner 2012)

Patient Safety

18

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 23: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Interviewing

Newly graduated nurses entering practice during the COVID-19 pandemic may need additional information on how to prepare for and interview for employment Considerations include

Create a professional resumeEvaluate your social media footprint Eliminate unprofessional pictures and posts (though remember they are still retrievable)Choose the organizations of interest and familiarize yourself with their websites including the organizations mission and vision note if the organization part of a larger network or healthcare system and if they are known for certain specialties Take care to review nursing department links and note if there is evidence of shared governance professional development opportunities tuition support continuing education and opportunities for advancement Also note the number of open positions If you have never interviewed practice Select somewhere you will not actually work and get the kinks out of the experience before you go to your next one Practice interviews with a friend and give each other constructive criticismPlan your interview including your outfit Business attire (clean neat no heavy perfumes or lingering smoke and no gum) Bring extra copies of your resume and prepare questions Why does the interviewer(s) enjoy working at the organization andor on that unit How would they describe the unit culture and the organizational culture Ask for examples to describe the culture How many new nurses are likely to be on orientation What are the best aspects of the facility What are they most proud of about the organization and the unitAsk about new graduate orientation

What can you expect for orientation At least 8 weeks is the average for specialties orientation could be 12-16 weeks or longerResidency programs components such as classroom seminar andor support group elements as well as evidence-based projectsPreceptors How are they chosen How many preceptors would you have Do you follow their schedule or do you follow a set schedule with multiple preceptors Do you share an assignment with the preceptor or do they have their own assignment How do off-shifts work during orientationWho are the resources for new nurses preceptors educators or others What type of preceptor model do they useHow are you evaluated on orientationIs there an option to extend orientation if neededWhat supports are available after orientation Is there a New Graduate Transition Group a support system or a mentoring initiative in place for nurses as the move into competent practice

19

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 24: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Prepare for behaviorally-based interviewing Look up behaviorally-based interviewing and be prepared to talk about clinical scenarios or team interactions you are proud of and be prepared to share these examplesIf you have had previous careers include some of those responsibilities in your resume Previous experience in supervisory or leadership roles customer service and peer leadership are all valuable in nursing rolesDo a practice visit to find your facility time your travel and allow extra time the day of your interview for traffic parking etcPlan to be interviewed by multiple people group interviews are more common and may consist of a manager educator and staff to determine your fit for the unitAsk if there is an opportunity to participate in a shadow experience so that you have first-hand knowledge about the patient population and culture within the unitBe prepared to answer questions about your five-year plan and aspirationsBring a complete package of documents to share andor be prepared to share them electronically If you have a professional portfoliomdash bring it it will make you stand out They will also likely want to see references transcripts

Thank the interviewer(s) and send a thank you notehellipit will make you stand out

Good luck

20

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 25: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

NCLEX-RN Preparation

Remaining prepared for the NCLEX-RN exam is critical for newly graduated nurses Whether new nurses are hired and practicing in a graduate nurse role or looking for employment while studying for the NCLEX it is critical that test preparation continues until the day of the exam Many organizations plan to offer NCLEX preparation as part of the new nurse orientation program or residency program and this is considered a best practice for organizations that hire graduate nurses There are four apps that can be purchased for a relatively low cost to help new nurses stay prepared for the NCLEX exam We do not endorse any of these programs but are sharing them as resources

NCLEX Mastery The full version of this highly-rated app offers 1600 digital flashcards with rationales and pictures plus 350 pharmacology questions Questions are based on past NCLEX exams and a built-in timer shows you how long yoursquore taking on each one Other goodies a comprehensive list of NCLEX mnemonics and a prefix suffix and vocabulary section $2499 (soon to be going up to $3999) iOSreg and Androidtrade

Saunders Mobile Review Questions for the NCLEX-RNreg Exam Based on questions from the bestselling review book Test it out with a free 25-question lite version or download the full app to get 1500 questions and the ability to create customized quizzes You can also purchase additional questions 500 at a time with in-app purchasing Questions are written by NCLEX prep expert Linda Anne Silvestri PhD RN The app features numerous alternate-format items including audio and video questions $2999 iOS HESIreg QampA for the NCLEX-RN Exam From the makers of the HESI series of nursing exams this app includes 600 critical-thinking style practice questions in six different content areas ndash Medical-Surgical Nursing Pharmacology Pediatrics Fundamentals Maternity and Psychiatric-Mental Health Nursing Take a comprehensive exam or create a customized quiz on the topics you need to study the most No Internet access required for use Use the ldquostudy moderdquo to review the rationale for every question $2499 iOSATI RN Mentor This quiz app includes 800+ NCLEX-style questions that span a number of formats multiple choice ordered response select all that apply image hot-spot and chart exhibit Choose the topics and number of questions to generate customized quizzes Each question features detailed rationales for both correct and incorrect answers App includes a built-in calculator $1999 iOs and Android

21

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 26: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Conclusion

In addition to staying prepared for the NCLEX-RN licensure exam nurses entering practice for the first time may feel challenged in learning clinical skills A plethora of resources are provided in Appendices H- I to assist educators in supporting the immediate learning needs of new nurses transitioning into practice Appendix J provides resources specific to COVID-19 including videos on personal protective equipment (PPE) caring for specific patient populations and resources for resilience and psychosocial well-being Cues to address disruptive behavior are provided in Appendix K as disruptive behaviors may be more prevalent during this pandemic period Lastly Appendix L identifies a few certification programs that may be of interest to new nurses

Additional Resources

Academic and practice educators share a concern and commitment to ensuring new nurses transition smoothly into practice The COVID-19 pandemic served as a catalyst to convene a taskforce charged with producing strategies that could be developed between academic and practice partners to collaboratively support new nurse transition into practice during this dynamic and uncertain time Resources to assess and develop clinical preceptors were provided along with a framework to provide virtual support groups for new nurses Resources to support these strategies as well as competency-based professional development and interview and NCLEX-RN preparation for new nurses were also provided This taskforce was co-led by the Organization of Nurse Leaders (ONL) and the Massachusetts Rhode Island League for Nursing (MARILN) Members of this taskforce donated their time and expertise and hope recommendations shared in this report will be implemented in HCOs and that new nurses will have a successful transition into practice during the COVID-19 pandemicQuestions requests or feedback on the strategies outlined in this report can be emailed directed to infooonlorg

22

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 27: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

References

Agency for Healthcare Research and Quality (AHRQ) (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtml Altmiller G et al (2018) Constructive feedback teaching strategy A multisite study of its effectiveness Nursing Education Perspectives 39 291ndash296 httpsdoiorg10109701NEP0000000000000385 American Nurses Association (2020) End nurse abuse support educate take action share Retrieved from httpswwwnursingworldorgpractice-policywork-environmentend-nurse-abuse Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor support in hospital transition to practice programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278 Boyer S A (2008) Competence and innovation in preceptor development updating our programs Journal for Nurses in Staff Development 24(2) E1ndashE6 httpsdoiorg10109701NND0000300872438570b Bontrager S Hart P L amp Mareno N (2016) The role of preceptorship and group cohesion on newly licensed Registered Nursesrsquo satisfaction and intent to stay Journal of Continuing Education in Nursing 47(3) 132-139 httpsdoiorg10392800220124-20160218-09 Brook J Aitken L Webb R MacLaren J amp Salmon D (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses A systematic review International Journal of Nursing Studies 91 47ndash59 httpsdoiorg101016jijnurstu201811003 Clark C M amp Fey M K (2019) Fostering civility in learning conversations Introducing the PAAIL communication strategy Nurse Educator 45 139ndash143 httpsdoiorg101097NNE0000000000000731 Clark C (2015) Conversations to inspire and promote a more civil workplace American Nurse Today10(11) 18-23 Retrieved from httpwwwmyamericannursecomwp-contentuploads201511Clark-Healthy-Workplace-Inventorypdf Cotter E Eckardt P amp Moylan (2018) Instrument development and testing for selection of nursing preceptors Journal of Nurses in Professional Development 34(4) 185-193 Delfino P Williams JL Wegener J amp Homel P (2014) The preceptor experience The impact of the VNIP model on nursing orientation Journal of Nurses in Professional Development 30 (3) 122-126

23

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 28: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Finn FL amp Chesser-Smyth P (2013) Promoting learning transfer in preceptor preparation Journal of Nurses in Professional Development 29(6) 309-315 Forneris S G amp Fey M (Eds) (2018) Critical conversations The NLN guide for teaching thinking Philadelphia Wolters Kluwer Friedman M I Delaney M M Schmidt K Quinn C amp Macyk I (2013) Specialized new graduate rn pediatric orientation a strategy for nursing retention and its financial impact Nursing Economics 4 162-171 Granger B B Prvu-Bettger J Aucoin J Fuchs M A Mitchell P H Holditch-Davis D Roth D Califf R M amp Gilliss C L (2012) An academic-health service partnership in nursing lessons from the field Journal of Nursing Scholarship 44(1) 71-79 Griffin M (2004) Teaching cognitive rehearsal as a shield for lateral violence An intervention for newly licensed nurses The JournaI of Continuing Education in Nursing 35 (5) 257-263 Innes T Calleja P (2018) Transition support for new graduate and novice nurses in critical care settings An integrative review of the literature Nurse Education and Practice 30 62-72 doi101016jnepr201803001 Kovner C T Brewer C S Fatehi F amp Katigbak C (2014) Changing trends in newly licensed RNs The American Journal of Nursing 114(2) 26ndash34 httpsdoiorg10109701NAJ0000443767200117f Longo J (2017 August 30) Cognitive rehearsal American Nurse Retrieved from httpswwwmyamericannursecomcognitive-rehearsal Massachusetts Department of Higher Education (2016) Massachusetts Nurse of the Future Core Competencies Registered Nurse httpswwwmassedunahidocumentsNOFRNCompetencies_updated_March2016pdf McDonald AW amp Ward-Smith P (2012) A review of evidence-based strategies to retain graduate nurses in the profession Journal for Nurses in Staff Development 28(1)16-20 Monagle J L Lasater K Stoyles S amp Dieckmann N (2018) New graduate nurse experiences in clinical judgment what academic and practice educators need to know Nursing Education Perspectives 39(4) 201ndash206 httpsdoiorg10109701NEP0000000000000336 National Council of State Boards of Nursing (NCSBN) (2020) Transition to practice learning courses httpsww2learningextcomnewnurseshtm National Health Services Improvement (2018) A just culture guide National Health Services httpsimprovementnhsukresourcesjust-culture-guide

24

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 29: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Nielsen A Stragnell S amp Jester P (2007) Guide for reflection using the Clinical Judgment Model Journal of Nursing Education 46 513-516 doi 10392801484834-20071101-06 Nursing Solutions Inc (2020) 2020 National healthcare retention and RN staffing report Retrieved from httpswwwnsinursingsolutionscomDocumentsLibraryNSI_National_Health_Care_Retention_Reportpdf Nursing Executive Center (2019) The nurse preceptor toolkit A leaderrsquos guide to developing and inspiring high-performing preceptors Advisory Board Washington DC Oppel E amp Mohr DC (2020) Multilevel analysis exploring the relative importance of workplace resources in explaining nursesrsquo workload perceptions Are we setting the right focus Health Care Management Review httpsdoiorg101097HMR0000000000000285 Opperman C Liebig D Bowling J Johnson C S amp Harper M (2016) Measuring return on investment for professional development activities a review of the evidence Journal for Nurses in Professional Development 32(3) 122ndash129 httpsdoiorg101097NND0000000000000262 Pellico L Brewer C amp Kovner C (2009) What newly licensed registered nurses have to say about their first experiences Nursing Outlook 57(4) 194-203 Phillips C (2020) Relationships between workload perception burnout and intent to leave among medicalndashsurgical nurses International Journal of Evidence-Based Healthcare 18(2) 265-273 httpsdoiorg101097XEB0000000000000220 Quality and Safety Education for Nurses (QSEN) (2020) QSEN Institute httpsqsenorg Shinners J Africa L amp Hawkes B (2016) Debriefing as a supportive component for registered nurses in transition Journal for Nurses in Professional Development 32(4) 212-218 Spector N Ulrich B Barnsteiner J (2017) Improving Quality and Safety with Transition-to-Practice in Quality and Safety in Nursing A Competency Approach to Improving Outcomes Second Edition Spector N Ulrich BT amp Barnsteiner J (2012) New graduate transition into practice Improving quality and safety In G Sherwood amp J Barnsteiner (Eds) Quality and safety in nursing A competency approach to improving outcomes (267-287) United Kingdom Wiley-Blackwell httpswwwncsbnorgSpector_New_Graduate_Transition_into_Practice_Improving_Quality_and_Safetypdf Sherwood amp J Barnsteiner Eds) J John Whiley and Sons Inc Retrieved from National Council of State Boards of Nursing (NCSBN) httpswwwncsbnorgQSENpdf

25

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 30: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Ulrich B Krozek C Early S Ashlock C H Africa L M amp Carman M L (2010) Improving retention confidence and competence of new graduate nurses results from a 10-year longitudinal database Nursing Economic$ 28(6) 363ndash375 Vermont Nurses in Partnership (nd) Clinical transition framework core components and evidence httpswwwvniporgdocumentsVNIP-CTF_EvidenceBase2017pdf Windey M Lawrence C Guthrie K Weeks D Sullo E amp Chapa D (2015) A systematic review on interventions supporting preceptor development Journal for Nurses in Professional Development 31(6) 312-232 Zak P J (2013 December 17) How stories change the brain Mind amp Body httpsgreatergoodberkeleyeduarticleitemhow_stories_change_brain

26

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 31: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

A Massachusetts Nurse of the Future Core Competencies- Registered Nurse Model

B Preceptor Gap Analysis

C Evidence-based Preceptor Selection and Development Checklist

D Preceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

E Preceptor Development Module 2 Clinical Judgment Continued

F Preceptor Development Module 3 How to Give Constructive Feedback

G Reflective Journaling Guide

H Resources to Support Professional Role Development Among New Nurses

I Resources to Clinical Skills Development Among New Nurses

J COVID-19 Resources

K Cues for Addressing Disruptive Behavior

L Certificate Modules

Appendices

27

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 32: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix A

(Massachusetts Department of Higher Education 2016)

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 33: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix B

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 34: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Cotter E Eckardt P amp Moylan L (2018) Instrument development and testing for selection of nursing preceptors J of Nurses in Professional Development 34(4) 185-193 Table shared for use at the point of care and only for educational purposes Where possible authors should be cited Do not copy and distribute freely as this would be a violation of copyright law

Appendix CEvidence-based Preceptor Selection amp Development Checklist

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 35: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Module ComponentsDidactic module on YouTubeViewing the didactic module will take approximately 20 minutes ArticlesGuides for developing critical thinking

2 articles about Clinical Judgment ModelTanner CA (2006) Thinking like a nurse a research-based model of clinical judgment in nursing Journal of Nursing Education 45(6) 204ndash211Monagle J Lasater K Stoyles S amp Dieckmann N (2018) New Graduate Nurse Experiences in Clinical Judgment What Academic and Practice Educators Need to Know Nursing Education Perspectives 39(4) 201ndash207 httpsdoiorg10109701NEP0000000000000336

2 guides for developing critical thinking among preceptees (cheat sheets) Questions to guide the preceptor in using the CJM to promote the development of critical thinking among precepteesUsing the Ladder of Inference

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix DPreceptor Development Module 1 Clinical Judgment Model (CJM) and Reflection

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 36: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Module ComponentsDidactic module on YouTube Viewing this didactic module will take just less than 10 minutesCase studiesArticles

2 case studies (one a non-nursing and a nursing one) for preceptors to practice utilizing the CJM model

GI Case StudyVeteran Teacher (non-nursing)

Articles1 article about how to plan for structured reflection

Baker CR (1996) Reflective learning a teaching strategy for critical thinking Journal of Nursing Education 35(1) 19ndash22

2 articles about preceptingBrook J Aitken L M Webb R MacLaren J amp Salmon D (2018) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses a systematic review International Journal of Nursing Studies 91 47-59Blegen M A Spector N Ulrich B T Lynn M R Barnsteiner J amp Silvestre J (2015) Preceptor Support in Hospital Transition to Practice Programs The Journal of Nursing Administration 45(12) 642ndash649 httpsdoiorg101097NNA0000000000000278

Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix EPreceptor Development Module 2 Clinical Judgment Continued

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 37: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Module componentsDidactic module on YouTube Articles

2 Articles on Constructive FeedbackAltmiller G et al (2018) Constructive Feedback Teaching Strategy A Multisite Study of Its Effectiveness Nursing Education Perspectives 39(5) 291ndash296 httpsdoiorg10109701NEP0000000000000385Clark C M amp Fey M K (2019) Fostering Civility in Learning Conversations Introducing the PAAIL Communication Strategy Nurse Educator 45(3) 139ndash143 httpsdoiorg101097NNE0000000000000731

Practice using the Preview Advocacy 1 Advocacy 2 Inquiry Listen (PAAIL) strategies and language presented in the Clark amp Fay (2019) article Articles are to be utilized at the point of care and only for educational purposes Where possible author(s) should be cited Do not copy and distribute freely as this would be a violation of copyright law Click here to access the preceptor module from the Organization of Nurse Leaders website (wwwoonlorg)

Appendix FPreceptor Development Module 3 How to Give Constructive Feedback

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 38: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix GReflective Journaling Guide

Directions Think about a clinical situation you encountered this past week and your nursing careresponse to the situation The situation can be a specific physiological patient problem such as an elevation in temperature respiratory difficulty or electrolyte imbalance an encounter with a patientrsquos family an ethical issue or an interaction who had in your role as a team member Use the guide for reflection as a way to tell the story of the situation you encountered The guide provides you with a way of thinking about care that supports the development of your clinical judgment

Introduction Describe a nursing situation you encountered this week

BackgroundDescribe your relationship to the patient at the time you noticed the situation Consider experiences you have had that helped you provide nursing care in this situation Describe your formal knowledge (eg physiology psychology communication skillshellip) previous nursing experience with a similar problem andor personal experiences that helped guide you as you worked with the patientDescribe your beliefs about your role as the nurse in working on the situationDescribe any emotions you had about the situation

Noticing What did you notice about the situation initially Describe what you noticed as you spent more time with the patient andor family

InterpretingDescribe what you thought about the situation (eg its cause potential resolutions patterns you noticed) Describe any similar situations you have encountered in practice before Describe any similarities and differences you observed when compared with the current situationWhat other information (eg assessment data evidence) did you decide you needed as you considered the situation How did you obtain this information What help with problem solving did you get from your instructor nurse or otherYour conclusion What did your observations and data interpretation lead you to believe How did they support your response to the situation Include pertinent pathophysiology andor psychopathology

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 39: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix G - ContinuedReflective Journaling Guide

Responding and Reflection-In-ActionAfter considering the situation what was your goal for the patient family andor staff What was your nursing response or what interventions did you do List all actions that you tookDescribe stresses you experienced as you responded to the patient or others involved in the situationWhat happened How did the patient family andor staff respond What did you do next

Reflection-on-Action and Clinical Learning Describe three ways your nursing care skills expanded during this experienceName three things you might do differently if you encounter this kind of situation again What additional knowledge information and skills do you need when encountering this kind of situation or a similar situation in the futureDescribe any changes in your values or feelings as a result of this experience

Exercise updated and based on Nielsen Stragnell amp Jester (2007)

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 40: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

The following resources are provided to enable nurse educators swift access to credible information that will support the professional role development of new nurses The resources provided are not intended to be exhaustive In many cases websites are provided and in other instances article citations are listed to indicate papers that may be informative for nurse educators interested in supporting the transition of new nurses into practice

Appendix HResources to Support Professional Role Development Among New Nurses

Bennerrsquos Role Development Stages (Novice Advanced Beginner Competent Proficient Expert and Master) with Dr Patricia Benner httpswwweducatingnursescom Nursing Theory Patricia Benner httpswwwyoutubecomwatchv=keLXuGLdIi4 Novice to Expert (fun) httpswwwyoutubecomwatchv=efuoDniRhOgampt=168s The National Council of State Boards of Nursingrsquos Transition to Practice Study Results httpswwwncsbnorg6889htm The National Council of State Boards of Nursingrsquos Transition to Practice Study Implications for Educators (two-page editorial) httpswwwncsbnorgSpector_JNEpdf A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program Return on Investment httpswwwncsbnorgROIpdf Transition to Practice Study Hospital Setting Results httpswwwncsbnorgSpector_Transition_to_Practice_Study_in_Hospital_Settingspdf Transition to Practice Study Non-hospital Setting Results httpswwwncsbnorgTTP_Phase_II_Finalpdf Retention Characteristics httpswwwncsbnorgRetention_Characteristicspdf Preceptorship Benefits httpswwwncsbnorgBlegan_JONApdf Transition to Practice- NCSBN Five Modules (NCBSN fee) httpswwwncsbnorgtransition-to-practicehtm

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 41: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix H - ContinuedResources to Support Professional Role Development Among New Nurses

Stephenson J amp Cosme S (2018) Instruments to evaluate nurse residency programs A review of the literature Journal for Nurses in Professional Development 34 (13) 123-132 (includes Casey Fink survey Confidence Competence Employment Satisfaction) Toolkit for Implementing the Massachusetts Nurse of the Future Core Competencies in Academic and Practice Settings Massachusetts Department of Higher Education (2016) httpswwwmassedunahidocumentsToolkit-First20Edition-May202014-r1pdf Agency for Healthcare Research and Quality (2020) TeamSTEPPS httpswwwahrqgovteamsteppsabout-teamsteppsindexhtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Leadership Briefing 20 httpswwwahrqgovteamsteppsabout-teamsteppsleadershipbriefinghtmlAgency for Healthcare Research and Quality (2020) TeamSTEPPS Instructor pocket guide httpswwwahrqgovteamsteppsinstructoressentialspocketguidehtmlClark C (2014) Conversations to inspire and promote a more civil work place American Nurse Today 10 (11) 18-23Longo J (2017) Cognitive rehearsal American Nurse Today 12(8) 1-8ANA Healthy Work Environment (2020) Includes Violence Incivility Bulllying and Nurse Abuse httpswwwnursingworldorgpractice-policywork-environment Interprofession Education Collaborative (IPEC) (2020) IPEC Core Competencies httpswwwipecollaborativeorgcore-competencieshtml The Joint Commission (2020) National Patient Safety Goals 2020 httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goalsChappell K amp Richards K (2015) New graduate nurses new graduate nurse transition programs and clinical leadership skill A systematic review Journal for Nurses in Professional Development 31 (3) 128-137

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 42: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix IResources to Clinical Skills Development Among New Nurses

Assessment SkillsHead to Toe Physical Assessment httpsnurseslabscomultimate-guide-to-head-to-toe-physical-assessmentBreath Sounds httpswwwnursingcentercomncblogoctober-2016breath-sounds-test-your-knowledge-Normal Lab Values Reference guide httpsnurseslabscomnormal-lab-values-nclex-nursingClinical Nursing Skills Learned in Nursing school with videos and Step-by-Step instructions httpswwwregisterednurserncomnursing-skills-clinical-nursing-skills-learned-in-nursing-school

Medications and Calculations7 Medication Safety Tips New Nurses Must Know httpsnurseslabscomhere-are-7-medication-safety-tips-new-nurses-must-knowBasic Nursing Dosage Calculations 1 httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampampview=detailampmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampampFORM=VRDGARampru=2Fvideos2Fsearch3Fq3DDosage2BCalculations2Bfor2BBeginners26FORM3DRESTABHow to Basic Medication Dosage Calculations httpswwwbingcomvideossearchq=Dosage+Calculations+for+Beginnersampru=2fvideos2fsearch3fq3dDosage2bCalculations2bfor2bBeginners26FORM3dRESTABampview=detailampmid=4D6416B90B1F49570E8F4D6416B90B1F49570E8Famprvsmid=C03EBCBF8A2433E9AEA9C03EBCBF8A2433E9AEA9ampFORM=VDRVRV

IV Therapy and PhlebotomyPrevention of Intravascular Catheter-Related infection httpswwwcdcgovinfectioncontrolguidelinesbsiindexhtmlIV Insertion video httpswwwyoutubecomwatchv=PtiHk_ljCUgampfeature=emb_logoBest veins for IV insertion Drawing Blood (Venipuncture Tips) in Nursing Phlebotomy httpswwwyoutubecomwatchv=i53sj2r1hj0

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 43: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix I - ContinuedResources to Clinical Skills Development Among New Nurses

Foley Catheter InsertionCatheter Associated Urinary Tract Infection httpswwwnursingworldorg~4aede8globalassetspracticeandpolicyinnovation--evidenceclinical-practice-materialcauti-prevention-toolanacautipreventiontool-final-19dec2014pdfFemale Catheter Insertion httpswwwyoutubecomwatchv=Il0iJUNnq7kMale Catheter Insertion httpswwwyoutubecomwatchv=A493yBJtiQ0

Infection ControlInfection Prevention amp Control httpswwwnursingworldorgpractice-policywork-environmenthealth-safetyinfection-preventionCDC Hand Hygiene in Healthcare Settings httpswwwcdcgovhandhygieneUnderstanding the chain of infection httpswwwnursingworldorg~4af4cdglobalassetspracticeandpolicywork-environmenthealth--safetyinfectionpreventioncontrol-infographicpdf

Codes and Rapid Response3 code-blue-tips-for-new-nurses-survive-first-code httpsnursingcomblog3-code-blue-tips-for-new-nurses-survive-first-code1What to do During a Code Show Notes (podcast) httpswwwfreshrncomepisode-003-code-show-notesRapid Response Teams in Hospitals Increase Patient Safety httpswwwncbinlmnihgovpmcarticlesPMC2873718Mock Code simulation COVID-19 positive patient wwwbingcomvideossearchq=you+tube+mock+code+2020ampdocid=608045108327091373ampmid=C99E1566B01CBDF04AF2C99E1566B01CBDF04AF2ampview=detailampFORM=VIREMock Code httpswwwyoutubecomwatchv=H26wEHMGHJY

Wound CareWound Assessment httpsjournalslwwcomnursingFulltext201908000Wound_assessment__A_step_by_step_process16aspxWound Care 101 httpsjournalslwwcomnursingFulltext201910000Wound_Care_10110aspx

Patient SafetyHospital 2020 National Patient Safety Goals httpswwwjointcommissionorgstandardsnational-patient-safety-goalshospital-2020-national-patient-safety-goals

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 44: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix JCOVID-19 Resources

COVID-19 ResourcesAmerican Nurses Association (ANA) has a series of free webinars for all nurses Each 60-minute webinar covers a different aspect of this crisis and provides up-to-date information that can be applied immediately caring for COVID-19 patients httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruseducationana-covid-19-webinar-series CDC Coronavirus (COVID-19) httpswwwcdcgovcoronavirus2019-ncovindexhtml ANA in consortium with other nursing professional organizations also provides an excellent set of resources to support nurse mental health support and resilience during this pandemic- the Well-Being Initiative at httpswwwnursingworldorgpractice-policywork-environmenthealth-safetydisaster-preparednesscoronaviruswhat-you-need-to-knowthe-well-being-initiative

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 45: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix KCues for Addressing Disruptive Behavior

Often we need assistance addressing aggressive behavior Using scripted responses or cues can help Addressing disruptive behavior by using cues can improve our communication and build healthier work environments Below is a list of 10 disruptive behaviors and cues to guide responses

Verbal Affronts (covert or overt snide remarks or lack of openness) Cue The individuals I learn the most from are clear in their directions and feedbackNon-verbal Innuendo (raising of eyebrows making faces) Cues

I see from your facial expression that you might want to speak with me one to one Direct communication is better for patient safety What else do you need to know

Withholding Information (related to onersquos practice or a client) Cues

It is my understanding there is more I need to know to practice safelyIs this everything I need to know

Sabotage (setting up a negative situation) Cue There is more to this situation Could we meet in private to explore what happenedInfighting (bickering between peers- Always avoid walk away and move to a neutral area) Cue This is not the time or place Please stop We need to work as a teamUndermining Activities (turning away not available to help) Cue Help me understand how this may have happened ndash It seems different than what I understoodBackstabbing (complaining about someone and not speaking directly to them) Cue I feel uncomfortable talking about this situation without the person involved here to explain the facts Have you spoken to hellipBroken Confidences (failure to maintain trust) Cue That sounds like information that should remain confidentialScapegoating (attributing all that goes wrong to one individual) Cue I donrsquot think we can blame just one person Letrsquos look at the system for problemsFailure to Respect PrivacyGossiping (rumors) Cue I am not comfortable discussing this without permission Please do not repeat it This conversation is not appropriate

(adapted from GWU School of Nursing 2019 What to Say- Reflect and Use the Cue Card originally developed by Griffin (2004)

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 46: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

Appendix LCertificate Modules

New nurses are eligible to earn certificates through on-line educational modules Two examples of such modules are listed below End of Life ELNEC UndergraduateNew Graduate CurriculumOnline Curriculum Designed Specifically for Nursing Students Meets competencies and recommendations of the AACN CARES Document (2016) Taught online 6 one-hour modules Cost $2900 per student for 12 months of online access Teaching Resources are available to faculty using the curriculum by contacting elneccohorg One faculty member from your school needs to be identified as the designated administrator who is responsible for the integrity of the curriculumELNEC UndergraduateNew Graduate Module Titles and Objectives can be found here httpselnecacademyreliaslearningcomDataDefaultImagesELNEC-Undergraduate- Module-Titles-and-Objectivespdf Learn about ELNEC- trailer httpsvimeocom189353629 Institute of Healthcare Improvement (IHI) Open School Safety and Quality The Open Schoolrsquos Basic Certificate in Quality and Safety comprises 13 essential courses (free) indicated with an asterisk() Track your progress toward this milestone using the ldquoCertificatesrdquo tabAt the end of every lesson you complete a post-lesson assessment and lsquopassrsquo by scoring 75 percent or higher Donrsquot worry You may continue to retake the lesson until you are satisfied with your score Once you have completed all the lessons in a course you will receive credit for the course upon submission of a short survey More information can be found herehttpappihiorglmsspacertificates6cb1c614-884b-43ef-9abd-d90849f183d4utm_referrer=http2F2Fwwwihiorg2Feducation2FIHIOpenSchool2FCourses2FPages2FOpenSchoolCertificatesaspx

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here

Page 47: Supporting New Nurse Transition into Practice during the ......New Nurse Virtual Support Groups Competency-Based Professional Role Development New Nurse Competencies Interviewing NCLEX-

To reference this report use the following citation Supporting new nurse transition into practice during the COVID-19 pandemic opportunities for academic and practice nurse educator collaboration Organization of Nurse Leaders - MA RI NH CT VT (2020 July) httpswwwoonlorgeducation-public2

The Organization of Nurse Leaders - MA RI NH CT VT (ONL) is a not-for-profit professional membership organization for current and aspiring nurse leaders Its membership is comprised of more than 1100 nurses from across five New England states ONLrsquos mission is to advance a culture of health through excellence in nursing and it works in full collaboration with all other local and national professional healthcare organizations to promote and optimize the nursing profession More information on ONL can be found here

For more than 100 years the National League for Nursing (NLN) has been the premier organization for nurse faculty schools of nursing and leaders in nursing education NLN advances the field of nursing education through professional development research student exam services nurse educator certification public policy and networking The MassachusettsRhode Island League for Nursing (MARILN) is the statewide affiliate of the NLN affiliate of the national NLS More information can be found here